Daily stretching routine for lower back pain

Do you suffer from chronic lower back pain (LBP)? Did you doctor or physical therapist suggest daily stretches? The video below is a daily stretching routine for the lower back, meant to encourage you to stick to daily stretching by removing the need to think about your moves: simply put your favorite music on, and follow the prompts! In approximately 6 minutes you will be done with your stretches for the day. After a few weeks, enjoy increased mobility and reduced pain.

Detailed sequence

The goals of this video are to stretch the back in all directions, except in flexion (see note below) and to stretch the hips as tight hip muscles can put strain on the lower back.

Note: most of the time, LBP is caused by staying for a long period of time with the lower back in a rounded position, slumped, or in flexion. So the stretches featured are focused on restoring lower back extension rather than flexion. In a few cases, such as during pregnancy or if suffering from hyperlordosis, LBP can be due to the lower back being over extended, in which case the extension movements in this video should be replaced by flexion movements, such as pulling the knees toward the chest or reaching the hands toward the toes.

Cat/cow

To begin by warming up the back, on all fours, round the back on a breath in, and extend in on a breath out. Continue for 5 breaths.

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Child’s pose

Then sit your hips on your feet, and extend the arms forward, to decompress the lower back. Hold for 30 seconds.

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Hamstring stretch

Lay on your back, both legs straight, and bring your left leg toward the sky. At the top of the movement, gently pull with your hands or a stretching band for 2 seconds, then bring your leg back down. Repeat 10 times, then switch sides and repeat on the other side.

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Glute stretch

Still on your back, cross your right leg over your left leg and pull your left leg toward you by holding onto your thigh or lower leg. Hold for 30 seconds, then repeat on the other side.

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Back twist

Now bring your left leg over your right, knee bent, and hold it as far down as comfortably possible with your right hand, look to the left and bring your left arm out. Hold for 30 seconds, then repeat on the other side.

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Side bend

Return to a sitting position and put your right hand down next to your hip, and bring your left arm over your head to reach out as far to the side as possible while still facing forward. Hold for 15 seconds then switch to the other side. Repeat twice on each side.

To read more about LBP, see our related articles:

As always, make sure to ask your doctor or physical therapist before starting any new exercice regimen, and stop if any movement causes pain.

At Phila Massages, your therapists can include some of these stretches in the session or go over them with you to ensure proper positioning.

References (retrieved 9/7/19):

  1. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet

  2. https://www.mayoclinic.org/diseases-conditions/back-pain/symptoms-causes/syc-20369906

  3. http://www.backcare.org.uk/wp-content/uploads/2015/02/Exercises-for-Back-Pain-Factsheet.pdf

  4. http://mypainfeelslike.ie/mypainfeelslike/en_IE/Pathways-through-pain/stretching-and-exercises-for-back-pain.html

  5. https://www.nhs.uk/live-well/exercise/lower-back-pain-exercises/

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Copyright © Vidal Sports LLC 2019

Flexibility vs Mobility

The ideas of flexibility and mobility play a vital role in the fitness and rehab industry. One is just as important as the other, but one thing I’ve noticed throughout years of practice is that many times both terms are used interchangeably, when in fact, both hold completely separate meanings. How you integrate both into your training could be one of the main factors in injury prevention and performance.  

Difference between flexibility and mobility

Simply Defined:

Flexibility is defined as the ability of a muscle or muscle groups to lengthen or stretch. Keywords here are ‘muscle’ and ‘lengthen’.

Mobility is defined as the ability of a joint to move actively through its range of motion. Keywords here are ‘joint’ and ‘move’.

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In order to have good joint mobility, muscle flexibility is imperative. A person could have great flexibility but still have poor mobility because muscle flexibility is only one of many factors in how a given joint moves. The primary factor of how a joint moves is its structure – the shape of its bones, how they meet and the joint’s ligaments and tendons connect to those bones.  

Take a straddle split for example. Come into a wide-legged seated position. Feel the stretch all along the inside of your leg as you slowly inch your legs further apart. How far you could get your legs apart while maintaining and holding proper upright alignment will show you the stretch capacity and flexibility in your Adductor muscle group. On the other hand, if you perform something such as a standing side to side lunge, how well you control the movement while going back and forth will determine an area of hip mobility. Even though you’re using the same group of muscles, passively holding a stretch is not the same as actively utilizing the muscle and making it work as you stabilize and control it through space in a concentric and eccentric movement. Strength, coordination, and body awareness are also elements of mobility.

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Another example, this time using the shoulder. Interlace your hands behind your back, straighten your elbows and begin to raise your arms to the point of feeling a good stretch across the chest and in the front of the shoulder. This indicates flexibility in the Anterior Deltoid and Pectoral muscles. Now, take a resistance band in both hands. Keeping the elbows straight, begin to move both arms overhead and back. How far back you’re able to comfortably keep control of your shoulders during this movement will give you a gauge of shoulder mobility.

Muscles can have good flexibility but be overactive because they’re trying to make up for lack of stability elsewhere. Muscles that cross multiple joints are muscles that tend to move us. Stabilizing muscles tend to cross only one joint. When the stabilizers are not doing their job well – or a person's posture does not allow them to do their job – mover muscles try to stabilize. But because they cross multiple joints, they end up limiting joint mobility. Take the hamstrings as an example. Many people say tight hamstrings are what’s limiting them from touching their toes, but inflexibility isn’t the issue; the muscles are overactive. If someone’s stabilizer muscles aren’t strong enough to keep the pelvis in proper alignment, the front of the pelvis will tilt down. As a result, the back of the pelvis tilts upward (anterior tilt) causing a dip in the low back. Remember, the hamstrings attach to the back of the pelvis. So now when you fold forward, you have an overactive muscle already stretched to its max, making it seem impossible to touch your toes. Remember: a joint will move in the path of least resistance (Relative Flexibility). If one area is restricted due to poor flexibility and mobility, compensation patterns and potential injury now become a concern.

When to Integrate Flexibility Training

Within the last decade, studies have shown that flexibility training and stretching inhibit the body to produce power and strength by relaxing the nervous system. Obviously, not ideal before a workout and best to hold off until post-workout. When performing post-workout flexibility training, focus more so on static stretches; holding the stretches between 15-20 seconds. An example of a thorough option is practicing yin yoga.

 When to Integrate Mobility Training

When comparing mobility training to stretching, it has the opposite effect on your body. It enhances your nervous system, warms-up the muscles more efficiently and prepares the joints for exercise. Examples of mobility drills include foam rolling, dynamic stretching, bodyweight squat and lunge variations. Check out the video clip to the right showing a few examples of hip and shoulder mobility drills.

Sports massage can be helpful to identify areas lacking in mobility or flexibility. At Phila Massages, your therapist will integrate stretching in a session when needed, as well as demonstrate stretches or warm up routines so you can integrate flexibility and mobility training to your fitness routine.

 

References (accessed 08/09/2019):

  1. https://blog.johnsonfitness.com/blog/flexibility-and-mobility/

  2. https://bjsm.bmj.com/content/34/5/324

  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1250267/

  4. https://sites.udel.edu/coe-engex/tag/stretching/

  5. https://sites.udel.edu/coe-engex/2018/02/27/holding-your-stretch-is-holding-you-back/

  6. https://www.wired.com/2010/10/forget-pre-exercise-stretching/

  7. https://www.shape.com/fitness/tips/how-improve-mobility-versus-flexibility

  8. https://health.usnews.com/health-news/diet-fitness/fitness/articles/2018-05-29/heres-the-difference-between-flexibility-and-mobility-and-why-it-matters

Image references (accessed 08/12/2019):

  1. http://anitagoa.com/yoga-2/beginner-practice-3/attachment/arms-behind-interlace/

  2. https://www.lifehack.org/345771/36-pictures-see-which-muscle-youre-stretching

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Copyright © Vidal Sports LLC 2019

Guide to Self-Massage Tools

The efficacy of self-massage tools is often a debated topic. There are studies that determine that self-massage alone does nothing to increase range of motion or athletic performance [5].  However, there are also contradictory studies, stating that self-massage has profound benefits for range of motion and athletic performance [3]. While more research may still be needed, it is usually recommended to self-massage in between massage sessions. If nothing else, this gives the athlete heightened awareness of muscle tightness and mobility restrictions.

Below is a list of common massage tools and their indications.

 

Foam Rollers

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[1]

 Foam rollers are made of different materials with varying density and diameter. Foam rollers as we know them were invented in 1987 by Sean Gallagher, a physical therapist.  For all intents and purposes, the roller itself is basically anything that is broad, somewhat rigid, and cylindrical.  The shape is perfect for getting to larger areas of the body, such as the upper back and legs.

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[2]

Soft foam rollers, which are actually made of foam, are perfect for beginners. The lower density serves as a much less rigid surface with which to work. This makes the self-massage much less painful and will encourage you to practice your self-massage protocol more frequently. 

For more pressure, a more rigid roller, such as a PVC roller, or a studded roller with dense foam, can be used.

Tips: Self-massage can be a bit uncomfortable, but should never be painful. Limit sessions to no more than a couple of minutes per area to avoid injuring muscles. It is strictly contra-indicated to roll on bones and joint capsules.

Rollers are great for a broad surface area; for smaller surfaces, or to reach even deeper muscles, use balls.  

 

Balls

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Balls are also made from varying materials and diameters.  The best part is that they can easily be found anywhere.  Balls are best used for smaller, more precise areas of the body, such as the arms and lower legs.  When using balls for self-massage, it is best to start with larger ones and gradually try smaller diameters as needed.  Medicine balls work as a good starting point, as they are readily available in most gyms and have a large diameter with low density.

A lacrosse ball is usually a great size/density; tennis balls are also great for most smaller areas of the body. As with foam rollers, there are purpose built balls with studs that can be very effective too.

 

Handheld Tools

Handheld self-massage tools are varied and readily available. A couple of them are reviewed below.

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Massage canes generally have some sort of handle or grip, and a knob-like projection that can be used to apply sustained pressure to the upper back.

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Massage sticks are usually best for large muscle groups in the legs, such as the Quadriceps or the calves.






 

 

Percussion Devices

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Percussion devices have been around for a long while however cheaper manufacturing and better technology have made them more affordable recently. Aside from the expected benefits of massage, some studies have shown that the vibration from those tools can be effective in reducing delayed onset muscle soreness [5]. These percussion massagers can be used for larger and smaller areas as different end pieces can be used to adapt to the area worked.

 

As always, please check with your physician if you are injured before trying self-massage. And reach out to your sports massage therapist for more advice on self-massage tools and techniques.         

 

References (retrieved 7/8/19):

  1. Grabow, L. (2018). Higher Quadriceps Roller Massage Forces Do Not Amplify Range-of-Motion Increases nor Impair Strength and Jump Performance. Journal of Strength and Conditioning Research, 10.

  2. Lori Duncan DPT, M. C. (2016, 10 25). Foam Rolling: The Good, The Bad and The Ugly. Retrieved from Duncan Sports Therapy and Wellness: https://www.duncansportspt.com/2016/10/foam-rolling/

  3. Madoni, S. N. (2018). Effects of Foam Rolling on Range of Motion, Peak Torque, Muscle Activation, and the Hamstrings-to-Quadriceps Strength Ratios. Journal of Strength and Conditioning Research, 9.

  4. Manal Zein-Hammoud, P. (2015). Modeled Osteopathic Manipulative Treatments: A Review of Their in Vitro Effects on Fibroblast Tissue Preparations. Journal of the American Osteopathic Association, 12.

  5. Shagufta Imtiyaz, Z. V. (2014, 01 12). To Compare the Effect of Vibration Therapy and Massage in Prevention of Delayed Onset Muscle Soreness (DOMS). Retrieved from National Center for Biotechnology Information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3939523/

  6. Smith, J. C. (2018). Acute Effect of Foam Rolling and Dynamic Stretching on Flexibility and Jump Height. Journal of Strength and Conditioning Research, 6.

Image references (retrieved 7/8/19):

  1. https://www.lifelinefitness.com/foam-roller.html

  2. https://www.walmart.ca/en/ip/iron-body-fitness-acupoint-foam-roller/6000191124527

  3. http://ibegrit.com/product/begrit-4pcs-massage-ball-roller-set-lacrosse-and-spiky-ball-combo-pack-massage-balls-perfect-for-trigger-point-and-foot-massaging/

  4. https://www.amazon.com/Sivan-Health-Fitness-Pressure-Massage/dp/B00KWWRNTC

  5. https://www.amazon.com/Physical-Therapy-Original-Massage-Stick/dp/B07NRVY92S

  6. https://www.si.com/edge/2018/01/22/percussive-massage-therapy-theragun-recovery

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Copyright © Vidal Sports LLC 2019

GROIN STRAIN

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Every lower body movement connects in to your hips and pelvis.  At the base of your pelvis are your adductor muscles, also referred to as your inner thighs.  These muscles assist with adduction (pulling your legs together), flexion and medial rotation of the legs. 

Cause

A groin strain usually occurs from a sudden, awkward movement and often occurs with athletes that perform a lot of jumping, kicking, turning, sudden or lateral movements.  But it can also occur from lifting heavy objects or falling. 

Types of strains

A strain occurs when the muscle is overstretched.  There are 3 different types of groin strains from a simple over stretching of the adductors to partial or full tears. Less severe strains (grade 1) have no tears in the muscle fiber, moderate (grade 2) have some minor tears and the most severe (grade 3) tear more of the muscle fibers or all of them.

A doctor will diagnose a groin strain with a physical exam and tests such as an x-ray or MRI.

Symptoms

  • Pain with motion

  • Swelling or bruising

  • Limping

  • Redness or warmth

  • Over tight muscles or weakness  

Treatment

Right after the injury the main goal is to reduce pain and swelling.  To aid in this it is recommended to use ice, rest, elevate and compression of the groin region.  Your doctor may also recommend anti-inflammatories or ibuprofen.

After the acute stage of injury your doctor may recommend to start gently stretching the area (see some examples of stretches below), to apply heat to relax the tight muscles and may also recommend massage. 

Sports massage can help work relax and stretch the groin and surrounding muscle groups to aid in recovery and to help regain motion and balance. 

It is best to ease your way back into vigorous activities due to a higher recurrence rate with groin strains.

Groin stretch

Below are three stretches that can help your adductors once out of the acute stage of injury.

Standing Adductor stretch

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1.     Stretch one leg out to the side, keeping your other leg under your torso.

2.     Move into a lateral lunge.

3.     Your outstretched leg should have a straight knee and should feel the stretch in the inner thigh.



Seated Adductor stretch (butterfly stretch)

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1.     Sit with your feet together and knees bent. Grab your feet with your hands and place your arms on your thighs.

2.     Push your knees gently down toward the ground with your arms.

3.     Feel the stretch along your inner thighs.[D]



Supine Adductor stretch

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1.     Lay on your back, legs against the wall, legs and butt touching the wall.

2.     Let your legs fall to the side and relax in this position.

 

 

Picture references (retrieved 5/2/19) 

  1. https://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=a718efd4-8b6c-4b7b-af9c-adeb8a5e7745

  2. https://workoutlabs.com/exercise-guide/bodyweight-side-steps-lateral-lunges/

  3. https://workoutlabs.com/exercise-guide/butterfly-stretch/

References (retrieved 5/2/19)

  1. https://www.healthline.com/health/groin-strain#treatment

  2. https://www.medicalnewstoday.com/articles/321007.php

  3. https://www.summitmedicalgroup.com/library/adult_health/sma_groin_strain/

  4. https://www.verywellhealth.com/diagnosing-and-treating-groin-pulls-exercises-and-tips-4142070

  5. https://www.webmd.com/fitness-exercise/groin-pull#1

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Copyright © Vidal Sports LLC 2019

The Lower Anterior Leg: 3 Stretches and 3 Self-Massage Techniques

The lower anterior leg (the shin) contains a group of long, tendinous muscles that are responsible for dorsiflexion and eversion of the foot, extension of the toes, and assist with ankle stabilization. Specifically, the Tibialis Anterior is the largest and most superficial of the shin muscles, and runs down the length of the shin in front of the tibia bone. Overuse, over extension and improper conditioning entering endurance activities such as downhill running or running on uneven surfaces can overload in the Tibialis Anterior, and thus the muscle is often associated with running pain.

Here are a few examples of stretches and self-massage techniques if your muscles feel sore and tight after activity.

Three Stretches:

Standing stretch

Supporting yourself with your left hand, step into a forward lunge with your right leg. Gently gently flip your left foot into plantar flexion.  Lower into a deeper lunge to increase the stretch.

 

Seated stretch

Sit in a chair with your right foot firmly planted on the ground. Carefully slide your left foot backwards unto plantar flexion underneath the chair.

 

Side-lying stretch

Supporting yourself with your left forearm, lay on your left side on a yoga mat. Keeping your right leg straight and planted on the floor for support, flex your left knee and catch your ankle with your right hand. Pull your knee into a deeper flex to increase the stretch. 

 

Three Self-Massage Techniques:

Longitudinal Roll

Place the foam roller on the floor. Carefully place your lower leg on the roller. Internally rotate the leg to avoid rolling directly on the tibia bone. With your other leg on by your side for support, gently roll up and down to massage the muscles lengthwise. This can also be done using a roller stick or a tennis ball.

 

Cross Fiber Roll

Sit on the floor with you leg extended. Using a roller massage stick, start at the ridge of the tibia and work laterally towards the floor, being careful not to roll over the bone. This can also be done using a tennis ball.

 

Pin and Stretch

Sit on the floor with your leg extended. Place your roller stick on a trigger point. Hold firmly, and gently dorsiflex and plantar flex your foot. This can also be done using a tennis ball.

 

These techniques, along with regular sports massage sessions, can be used as preventative care against shin pain as you amp up your spring training!

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Copyright © Vidal Sports LLC 2019

Ankle Sprain

One of the most common injuries experienced by athletes is the sprained ankle. According to the British Journal of Sports Medicine [1], about 40% of all ankle sprain injuries that occur are sports-related. A large portion of those injured individuals will develop chronic ankle instability which results in persistent pain, swelling, or recurrent sprains for at least 12 months after the initial sprain. 

What is a sprain?

An ankle sprain is a musculoskeletal injury that occurs when the ankle is rolled, twisted or turned in an awkward way. Landing unbalanced from a jump, planting the foot awkwardly when running, or even simply walking on an uneven surface can be the cause of the injury. 

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[A]

The ankle joint, known as the talocrural joint, is made of three bones: tibia, fibula, and talus. Ankle joints are stabilized by ligaments that attach from bone to bone, passively limiting the range of motion at each joint. If the ankle moves in an unnatural way, the ligaments are forced to stretch beyond their normal range of motion, thus overstretching and/or creating a tear. The lateral ligaments of the ankle—anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) and posterior talofibular ligaments—tend to be the most commonly injured in sprained ankles. 

Grades of Sprains

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[B]

Grade 1 (Mild): slight stretching and micro-tearing of the ligament fibers; there may be mild tenderness and swelling around the ankle.

Grade 2 (Moderate): partial tearing of the ligament; moderate tenderness and swelling around the ankle and if the ankle is moved in a certain way, there may be a looseness of the ankle joint.

Grade 3 (Severe): a complete tear of the ligament; significant tenderness and swelling; if the ankle joint is pulled or pushed into certain movements, substantial instability occurs.

Treatment of Ankle Sprains

Depending on the severity of the sprain, there are a number of phases in which the treatment/rehabilitation process will go through. 

Phase 1: includes (active) resting, protecting the ankle and reducing swelling; this is the immediate action taken following the injury. (Active rest refers to refraining from doing the action that causes pain, such as any weight-bearing movement on the ankle.) Ice can be used in 20-minute increments to reduce pain and swelling, and compression via a bandage or walking boot may help reduce swelling.

Phase 2: focuses on restoring range of motion, strength and flexibility; mature scar formation takes about six weeks and during this time, it's important to focus on remolding the scar tissue in order to restore full function ankle movement and prevent a poorly formed scar that could increase the chance of re-tearing in the future. Strengthening the calf, ankle and foot muscles during this phase will help with gradual weight-bearing activity.

Phase 3: includes maintenance exercises and gradual return to activities that do not involve turning or twisting on the ankle—as this phase progresses, activities that involve those movements will be tolerable.

Prevention

Some tips that can help prevent a sprained ankle (or recurring sprain):

· Proper warmup before physical activity

· Wearing shoes that fit well and are made for the specific sport or activity

· Maintain good muscle strength and flexibility

· Practice stability training, including balance exercises (see below)

· Be aware when walking or running on uneven surfaces

· Use ankle support on a previously injured ankle, if necessary

Simple Balance Exercises (see reference [4] for a video of these exercises):

1.    Stand with feet together and bend right knee (bring foot behind) to a 90 degree angle, hold 30 seconds to 1 minute. Repeat on left side.

2.    Same exercise as above but with eyes closed. This can help with proprioception—the awareness of one's body in its environment—which can be affected after an injury.  

3.    With eyes open again and while holding yoga blocks in each hand, lift one foot off the ground and slowly bend at the waist to place one block on the floor. Return to upright position and bend again to place second block on the floor. Repeat while standing on opposite foot. 

Though much of the research done regarding manual therapy and ankle sprain recovery does not have strong findings, some studies show that manual therapy such as massage may provide short-term benefits after an ankle sprain. In addition, some studies also show that exercise, specifically balance-focused exercises, may reduce the risk of a recurring sprain.

Sources (viewed 11/30/18):

[1] https://bjsm.bmj.com/content/52/15/956.long

[2] https://www.sportsmed.theclinics.com/article/S0278-5919(16)30027-8/fulltext

[3] https://orthoinfo.aaos.org/en/diseases--conditions/sprained-ankle/

[4] https://youtu.be/ptF4doYU444

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3103112/

Image references (retrieved 11/30/18):

[A] https://physioworks.com.au/injuries-conditions-1/sprained-ankle 

[B] https://www.mayoclinic.org/diseases-conditions/sprained-ankle/symptoms-causes/syc-20353225 

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Copyright © Vidal Sports LLC 2018